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Environment International Sep 2020Air pollution is a leading cause of mortality and morbidity worldwide. Short-term exposure (from one hour to days) to selected air pollutants has been associated with... (Meta-Analysis)
Meta-Analysis
Short-term exposure to particulate matter (PM and PM), nitrogen dioxide (NO), and ozone (O) and all-cause and cause-specific mortality: Systematic review and meta-analysis.
BACKGROUND
Air pollution is a leading cause of mortality and morbidity worldwide. Short-term exposure (from one hour to days) to selected air pollutants has been associated with human mortality. This systematic review was conducted to analyse the evidence on the effects of short-term exposure to particulate matter with aerodynamic diameters less or equal than 10 and 2.5 µm (PM PM), nitrogen dioxide (NO), and ozone (O), on all-cause mortality, and PM and PM on cardiovascular, respiratory, and cerebrovascular mortality.
METHODS
We included studies on human populations exposed to outdoor air pollution from any source, excluding occupational exposures. Relative risks (RRs) per 10 µg/m increase in air pollutants concentrations were used as the effect estimates. Heterogeneity between studies was assessed using 80% prediction intervals. Risk of bias (RoB) in individual studies was analysed using a new domain-based assessment tool, developed by a working group convened by the World Health Organization and designed specifically to evaluate RoB within eligible air pollution studies included in systematic reviews. We conducted subgroup and sensitivity analyses by age, sex, continent, study design, single or multicity studies, time lag, and RoB. The certainty of evidence was assessed for each exposure-outcome combination. The protocol for this review was registered with PROSPERO (CRD42018087749).
RESULTS
We included 196 articles in quantitative analysis. All combinations of pollutants and all-cause and cause-specific mortality were positively associated in the main analysis, and in a wide range of sensitivity analyses. The only exception was NO, but when considering a 1-hour maximum exposure. We found positive associations between pollutants and all-cause mortality for PM (RR: 1.0041; 95% CI: 1.0034-1.0049), PM (RR: 1.0065; 95% CI: 1.0044-1.0086), NO (24-hour average) (RR: 1.0072; 95% CI: 1.0059-1.0085), and O (RR: 1.0043; 95% CI: 1.0034-1.0052). PM and PM were also positively associated with cardiovascular, respiratory, and cerebrovascular mortality. We found some degree of heterogeneity between studies in three exposure-outcome combinations, and this heterogeneity could not be explained after subgroup analysis. RoB was low or moderate in the majority of articles. The certainty of evidence was judged as high in 10 out of 11 combinations, and moderate in one combination.
CONCLUSIONS
This study found evidence of a positive association between short-term exposure to PM, PM, NO, and O and all-cause mortality, and between PM and PM and cardiovascular, respiratory and cerebrovascular mortality. These results were robust through several sensitivity analyses. In general, the level of evidence was high, meaning that we can be confident in the associations found in this study.
Topics: Air Pollutants; Air Pollution; Cause of Death; Environmental Exposure; Humans; Nitrogen Dioxide; Ozone; Particulate Matter; Time Factors
PubMed: 32590284
DOI: 10.1016/j.envint.2020.105876 -
Proceedings of the National Academy of... Aug 2023To date, no study has explored the extent to which genetic susceptibility modifies the effects of air pollutants on the risk of atrial fibrillation (AF). This study was...
To date, no study has explored the extent to which genetic susceptibility modifies the effects of air pollutants on the risk of atrial fibrillation (AF). This study was designed to investigate the separate and joint effects of long-term exposure to air pollutants and genetic susceptibility on the risk of AF events. This study included 401,251 participants without AF at baseline from UK Biobank. We constructed a polygenic risk score and categorized it into three categories. Cox proportional hazards models were fitted to assess the separate and joint effects of long-term exposure to air pollutants and genetics on the risk of AF. Additionally, we further evaluated the effect modification of genetic susceptibility. The hazard ratios and corresponding 95% confidence intervals of incident AF for per interquartile range increase in particulate matter with an aerodynamic diameter smaller than 2.5 µm (PM) or 10 µm (PM), nitrogen dioxide (NO), and nitrogen oxide (NO) were 1.044 (1.025, 1.063), 1.063 (1.044, 1.083), 1.061 (1.042, 1.081), and 1.039 (1.023, 1.055), respectively. For the combined effects, participants exposed to high air pollutants levels and high genetic risk had approximately 149.2% (PM), 181.7% (PM), 170.2% (NO), and 157.2% (NO) higher risk of AF compared to those with low air pollutants levels and low genetic risk, respectively. Moreover, the significant additive interactions between PM and NO and genetic risk on AF risk were observed, with around 16.4% and 35.1% of AF risk could be attributable to the interactive effects. In conclusion, long-term exposure to air pollutants increases the risk of AF, particularly among individuals with high genetic susceptibility.
Topics: Humans; Atrial Fibrillation; Nitrogen Dioxide; Prospective Studies; Genetic Predisposition to Disease; Environmental Exposure; Air Pollution; Air Pollutants; Particulate Matter; Nitric Oxide
PubMed: 37523535
DOI: 10.1073/pnas.2302708120 -
The Science of the Total Environment Jan 2023Evidence of both epidemiological and clinical studies exploring the impact of nitrogen dioxide (NO) on the systemic lupus erythematosus (SLE) disease activity have been...
BACKGROUND
Evidence of both epidemiological and clinical studies exploring the impact of nitrogen dioxide (NO) on the systemic lupus erythematosus (SLE) disease activity have been contradictory.
OBJECTIVES
To evaluate the association between short-term NO exposure and length of hospital stay (LOS) and hospital cost of SLE and estimate the burden of disease attributable to NO exposure.
METHODS
We collected health data of SLE inpatients who were hospitalized at secondary and tertiary hospitals in Hunan province of China during 2017-2019. Daily ambient concentrations of air pollutants (O, CO, NO, SO, PM and PM) and other environmental factors were obtained from public repositories by linking to individual addresses and date of hospitalization. Mixed effect models were employed to assess the associations between LOS and hospital cost for SLE inpatients and NO exposures during the previous 1 to 21 days (lag-lag) before hospitalization. We further estimated excess LOS and hospital cost attributable to NO exposure according to China's and World Health Organization's air quality guideline (AQG) respectively.
RESULTS
A total of 11,447 records from 221 hospitals were finally included in our study. After full adjustments, 1 μg/m increment of NO was significantly associated with 0.038 day increase in LOS (95%CI: 0.0159-0.0601, P = 0.0008) and 0.0384 thousand yuan increase in hospital cost (95%CI: 0.0017-0.0679, P = 0.0395) with a lagged effect of 7 days prior to admission. Based on the adjusted effects of lag, controlling for short-term NO exposure according to AQG could avoid up to 1.47 thousand days of hospitalization and 1.35 million yuan of cost for SLE in Hunan province during 2017 to 2019.
CONCLUSIONS
Excess LOS and substantial economic burden among SLE inpatients attributable to NO could be avoid if policies were implemented to reduce the exposure.
Topics: Humans; Nitrogen Dioxide; Length of Stay; Air Pollution; Air Pollutants; China; Lupus Erythematosus, Systemic; Hospitals; Particulate Matter
PubMed: 36162573
DOI: 10.1016/j.scitotenv.2022.159013 -
The Science of the Total Environment Jul 2021Ambient air pollution is among the greatest environmental risks to human health. However, little is known about the health effects of nitrogen dioxide (NO), a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ambient air pollution is among the greatest environmental risks to human health. However, little is known about the health effects of nitrogen dioxide (NO), a traffic-related air pollutant. Herein, we aimed to conduct a meta-analysis to investigate the long-term effects of NO on mortality.
METHODS
We conducted a systematic search for studies that were published up to February 2020 and performed a meta-analysis of all available epidemiologic studies evaluating the associations between long-term exposure to NO with all-cause, cardiovascular, and respiratory mortality. Overall pooled effect estimates as well as subgroup-specific pooled estimates (e.g. location, exposure assessment method, exposure metric, study population, age at recruitment, and key confounder adjustment) and 95% confidence intervals were calculated using random-effects models. Risk of bias assessment was accessed by following WHO global air quality guidelines. Publication bias was accessed by visually inspecting funnel plot and Egger's liner regression was used to test of asymmetry.
RESULTS
Our search initially retrieved 1349 unique studies, of which 34 studies met the inclusion criteria. The pooled hazard ratio (HR) for all-cause mortality was 1.06 (95%CI: 1.04-1.08, n = 28 studies, I = 98.6%) per 10 ppb increase in annual NO concentrations. The pooled HRs for cardiovascular and respiratory mortality per 10 ppb increment were 1.11 (95%CI: 1.07-1.16, n = 20 studies, I = 99.2%) and 1.05 (95%CI: 1.02-1.08, n = 17 studies, I = 94.6%), respectively. The sensitivity analysis pooling estimates from multi-pollutant models suggest an independent effect of NO on mortality. Funnel plots indicate that there is no evidence for publication bias in our study.
CONCLUSION
We provide robust epidemiological evidence that long-term exposure to NO, a proxy for traffic-sourced air pollutants, is associated with a higher risk of all-cause, cardiovascular, and respiratory mortality that might be independent of other common air pollutants.
Topics: Air Pollutants; Air Pollution; Environmental Exposure; Humans; Nitrogen Dioxide; Particulate Matter
PubMed: 33640547
DOI: 10.1016/j.scitotenv.2021.145968 -
Environmental Research Nov 2021Ambient air pollution has been characterized as a leading cause of mortality worldwide and has been associated with cardiovascular and respiratory diseases. There is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ambient air pollution has been characterized as a leading cause of mortality worldwide and has been associated with cardiovascular and respiratory diseases. There is increasing evidence that short-term exposure to nitrogen dioxide (NO), is related to adverse health effects and mortality.
METHODS
We conducted a systematic review of short-term NO and daily mortality, which were indexed in PubMed and Embase up to June 2021. We calculated random-effects estimates by different continents and globally, and tested for heterogeneity and publication bias.
RESULTS
We included 87 articles in our quantitative analysis. NO and all-cause as well as cause-specific mortality were positively associated in the main analysis. For all-cause mortality, a 10 ppb increase in NO was associated with a 1.58% (95%CI 1.28%-1.88%, I = 96.3%, Eggers' test p < 0.01, N = 57) increase in the risk of death. For cause-specific mortality, a 10 ppb increase in NO was associated with a 1.72% (95%CI 1.41%-2.04%, I = 87.4%, Eggers' test p < 0.01, N = 42) increase in cardiovascular mortality and a 2.05% (95%CI 1.52%-2.59%, I = 78.5%, Eggers' test p < 0.01, N = 38) increase in respiratory mortality. In the sensitivity analysis, the meta-estimates for all-cause mortality, cardiovascular and respiratory mortality were nearly identical. The heterogeneity would decline to varying degrees through regional and study-design stratification.
CONCLUSIONS
This study provides evidence of an association between short-term exposure to NO, a proxy for traffic-sourced air pollutants, and all-cause, cardiovascular and respiratory mortality.
Topics: Air Pollutants; Air Pollution; Environmental Exposure; Nitrogen Dioxide; Particulate Matter
PubMed: 34331919
DOI: 10.1016/j.envres.2021.111766 -
The European Respiratory Journal Sep 2014Exposure to ambient nitrogen dioxide (NO2) has been linked to increased mortality in several epidemiological studies but the question remains of whether NO2 is directly... (Meta-Analysis)
Meta-Analysis Review
Exposure to ambient nitrogen dioxide (NO2) has been linked to increased mortality in several epidemiological studies but the question remains of whether NO2 is directly responsible for the health effects or is only an indicator of other pollutants, including particulate matter. The aim of the present review was to provide pooled estimates of the long-term effects of NO2 on mortality, which are potentially useful for health impact assessment. We selected 23 papers, published from 2004 to 2013, evaluating the relationship between NO2 and mortality, also including an assessment of the effect of particulate matter exposure. A random-effects meta-analysis was carried out on 19 studies. The pooled effect on mortality was 1.04 (95% CI 1.02-1.06) with an increase of 10 μg · m(-3) in the annual NO2 concentration and 1.05 (95% CI 1.01-1.09) for particulate matter <2.5 μm in diameter (PM2.5) (10 μg · m(-3)). The effect on cardiovascular mortality was 1.13 (95% CI 1.09-1.18) for NO2 and 1.20 (95% CI 1.09-1.31) for PM2.5. The NO2 effect on respiratory mortality was 1.03 (95% CI 1.02-1.03) and 1.05 (95% CI 1.01-1.09) for PM2.5. Four bipollutant analyses with particulate matter and NO2 in the same models showed minimal changes in the effect estimates of NO2. There is evidence of a long-term effect of NO2 on mortality as great as that of PM2.5. An independent effect of NO2 emerged from multipollutant models.
Topics: Air Pollutants; Air Pollution; Cardiovascular Diseases; Humans; Longitudinal Studies; Mortality; Nitrogen Dioxide; Particulate Matter; Research Design; Risk Factors; Treatment Outcome
PubMed: 24558178
DOI: 10.1183/09031936.00114713 -
Journal of Cardiac Failure Jun 2022Empirical evidence suggests a strong link between exposure to air pollution and heart failure incidence, hospitalizations, and mortality, but the biological basis of... (Observational Study)
Observational Study
BACKGROUND
Empirical evidence suggests a strong link between exposure to air pollution and heart failure incidence, hospitalizations, and mortality, but the biological basis of this remains unclear. We sought to determine the relationship between differential air pollution levels and changes in cardiac structure and function in patients with dilated cardiomyopathy.
METHODS AND RESULTS
We undertook a prospective longitudinal observational cohort study of patients in England with dilated cardiomyopathy (enrollment 2009-2015, n = 716, 66% male, 85% Caucasian) and conducted cross sectional analysis at the time of study enrollment. Annual average air pollution exposure estimates for nitrogen dioxide (NO) and particulate matter with diameter of 2.5 µm or less (PM) at enrolment were assigned to each residential postcode (on average 12 households). The relationship between air pollution and cardiac morphology was assessed using linear regression modelling. Greater ambient exposure to NO was associated with higher indexed left ventricular (LV) mass (4.3 g/m increase per interquartile range increase in NO, 95% confidence interval 1.9-7.0 g/m) and lower LV ejection fraction (-1.5% decrease per interquartile range increase in NO, 95% confidence interval -2.7% to -0.2%), independent of age, sex, socioeconomic status, and clinical covariates. The associations were robust to adjustment for smoking status and geographical clustering by postcode area. The effect of air pollution on LV mass was greatest in women. These effects were specific to NO exposure.
CONCLUSIONS
Exposure to air pollution is associated with raised LV mass and lower LV ejection fraction, with the strongest effect in women. Although epidemiological associations between air pollution and heart failure have been established and supported by preclinical studies, our findings provide novel empirical evidence of cardiac remodeling and exposure to air pollution with important clinical and public health implications.
Topics: Air Pollutants; Air Pollution; Cardiomyopathy, Dilated; Cross-Sectional Studies; Female; Heart Failure; Humans; Male; Nitrogen Dioxide; Prospective Studies; Ventricular Remodeling
PubMed: 35027315
DOI: 10.1016/j.cardfail.2021.11.023 -
The Science of the Total Environment Nov 2020Long-term exposure to air pollution is linked with increased risk of adverse health outcomes, but the evidence for the association between nitrogen dioxide (NO) and...
BACKGROUND
Long-term exposure to air pollution is linked with increased risk of adverse health outcomes, but the evidence for the association between nitrogen dioxide (NO) and mortality is weak because of the inadequate adjustment of potential confounders and limited spatial resolution of the exposure assessment. Moreover, there are concerns about the independent effects of NO. Therefore, we examined the association between NO long-term exposure and all-cause and cause-specific mortality.
METHODS
We included participants who were enrolled in health checkups in Okayama City, Japan, in 2006 or 2007 and were followed until 2016. We used a land-use regression model to estimate the average NO concentrations from 2006 to 2007 and allocated them to the participants. We estimated hazard ratios (HRs) for a 10-μg/m increase in NO levels for all-cause or cause-specific mortality using Cox proportional hazard models.
RESULTS
After excluding the participants who were assigned with outlier exposures, a total of 73,970 participants were included in the analyses. NO exposure was associated with increased risk of mortality and the HRs and their confidence intervals were 1.06 (95% CI: 1.02, 1.11) for all-cause, 1.02 (0.96, 1.09) for cardiopulmonary, and 1.36 (1.14, 1.63) for lung cancer mortality. However, the elevated risks became equivocal after the adjustment for fine particulate matter except lung cancer.
CONCLUSION
Long-term exposure to NO was associated with increased risk of all-cause, cardiopulmonary, and lung cancer mortality. The elevated risk for lung cancer was still observable even after adjustment for fine particulate matter.
Topics: Air Pollutants; Air Pollution; Cause of Death; Environmental Exposure; Humans; Japan; Nitrogen Dioxide; Particulate Matter
PubMed: 32887012
DOI: 10.1016/j.scitotenv.2020.140465 -
Revista Medica de Chile Oct 2021The Chilean Metropolitan region is exposed to nitrogen dioxide levels that are above the WHO Air Quality Guidelines.
BACKGROUND
The Chilean Metropolitan region is exposed to nitrogen dioxide levels that are above the WHO Air Quality Guidelines.
AIM
To report the exposure to nitrogen dioxide levels and to estimate the damage that these levels can cause in health.
MATERIAL AND METHODS
Description of nitrogen dioxide levels in the Chilean Metropolitan Region between 2016 and 2018 and the attributable risk of these levels on the population health.
RESULTS
The average hourly levels of nitrogen dioxide exceeded 40 pg/m3. In the three years studied, 11,686 attributable health problems were estimated, including deaths, hospitalizations, and attendance to emergency rooms.
CONCLUSIONS
We provide valid information to review and adjust primary air quality standards for nitrogen dioxide. The exposed population should be educated about the risk of this exposure to promote self-care.
Topics: Air Pollution; Chile; Hospitalization; Humans; Nitrogen Dioxide; Risk Factors
PubMed: 35319628
DOI: 10.4067/s0034-98872021001001391 -
International Journal of Molecular... Feb 2021Since the discovery in 1922 of 2,2-diphenyl-1-(2,4,6-trinitrophenyl) hydrazyl stable free radical (DPPH), the chemistry of such open-shell compounds has developed... (Review)
Review
Since the discovery in 1922 of 2,2-diphenyl-1-(2,4,6-trinitrophenyl) hydrazyl stable free radical (DPPH), the chemistry of such open-shell compounds has developed continuously, allowing for both theoretical and practical advances in the free radical chemistry area. This review presents the important, general and modern aspects of the chemistry of hydrazyl free radicals and the science behind it.
Topics: Electron Spin Resonance Spectroscopy; Free Radicals; Halogens; Models, Chemical; Molecular Structure; Nitrogen Dioxide
PubMed: 33546504
DOI: 10.3390/ijms22041545